Healthcare. Politics. Family.

A New Player in Team-Based Care

Published in the January 2011 AAMC Reporter

By Whitney L.J. Howell, special to the Reporter

By 2015, the face of advanced practice nursing will look markedly different thanks to a 2004 American Association of Colleges of Nursing vote. The goal: all nurses trained at this level will enter the work force with a doctorate-level degree. With the future of health care looking more and more like a team sport, and with health care officials increasingly looking to inject research findings more effectively into everyday practice, nursing experts say this new brand of practitioner could alter the clinical landscape.

Controversial within the nursing profession, the doctorate of nursing practice (DNP) is designed to produce clinical scholars who can easily translate research into both individual and population-based care models. The DNP—rather than the master’s—is now the terminal degree for nurse practitioners, nurse midwives, clinical nurse specialists, and nurse anesthetists, and is intended to be the nursing equivalent to the medical degree or pharmacy doctorate.

“The DNPs have the same skill sets as existing advanced practice nurses, but they’re increasing their relevance because they have additional analysis, patient management, and evidence-based skills that today’s health care settings need,” said Kathleen Potempa, Ph.D., RN, American Association of Colleges of Nursing (AACN) president. “They’re on the cutting edge.”

In addition to the coursework offered in master’s programs, DNP curricula focus on competencies in translating research, providing leadership for evidence-based practice, using research in decision-making, and implementing clinical innovations into practice. DNP-prepared nurses will practice in the same environments where advanced practice nurses work – hospitals, community health centers, urgent care facilities, and standalone health care practices.

In 2009, the first 660 DNP graduates entered the clinical work force. According to AACN data, 120 DNP programs currently exist, and they are growing in popularity. More than 160 nursing schools are planning similar curricula, and between 2008 and 2009, the number of matriculants jumped by 51.2 percent to nearly 5,200 students.

Teaching hospitals are already seeing the advantages of the DNP in patient care delivery and as part of a team-based approach to care.

“The DNPs in the hospital take care up a notch,” said Judy Pechacek, vice president of patient care at Fairview Southdale Hospital, a teaching hospital in Minnesota-based Fairview Health Services System. “They are ready at the point of care to tackle highly complicated, rare events and can dig in to look at all the evidence surrounding a case. Their knowledge makes them excellent team leaders when discussing treatment options for patients.”

Pechacek recalled how a DNP at Fairview once used the advanced research skills learned in the DNP program to search a database of medical literature to identify symptoms, conditions, and markers for a pregnant patient with an amniotic embolism, a rare and serious condition. The woman and the baby both had positive outcomes.

In its October report, “The Future of Nursing: Leading Change, Advancing Health,” the Institute of Medicine (IOM) recommended nurses achieve higher education and training levels as they increasingly fill primary care roles in the expanding health care system. The IOM committee pointed to the growing use of complicated technology systems and nurses’ role in coordinating care from multiple providers, including physicians, pharmacists, and physical therapists, as the basis for supporting the DNP.

However, the committee also concluded the degree is too new to accurately assess its impact on patient care thus far. Mary Terhaar, DNSc, RN, interim director of Johns Hopkins’ DNP program, disagreed, saying DNPs bring more statistical and epidemiological data, as well as additional evidence-based knowledge to discussions with health care teams about the best plan of care for particular patients. The enhanced skill set improves the teams’ ability to provide the best care, but most hospitals and clinics have not yet determined how best to use these nurses.

“Right now, our graduates are encountering situations where supervisors and hospital officials are trying to understand what they can ask of the nurses, what they can do with the new skill sets,” Terhaar said. “They’re having to rewrite position descriptions, and there’s no template for doing that.”

Not everyone in the nursing profession is convinced the DNP is necessary. Some health care leaders worry that DNP programs will siphon away potential Ph.D. applicants, or that patients will confuse DNPs with physicians, said Kathleen Dracup, DNSc, RN, dean of the University of California, San Francisco School of Nursing. The push for the degree is also coming at a tenuous time, she said.

“As health care reform rolls out, we’re facing increased demand for primary care, and we have a physician shortage,” she said. “Currently, advanced practice nurses, such as nurse practitioners, are meeting needs very well. Extending the time needed to earn the terminal degree for advanced practice will only limit patient access to care.”

Who am I?

I’m a seasoned reporter, writer, freelancer and public relations specialist with a master’s degree in international print journalism from The American University in Washington, D.C.

I launched my journalism career as a stringer for UPI on Sept. 11, 2001, on Capitol Hill. That day led to a two-year stint as a daily political reporter in Montgomery County, Md. As a staff writer for the Association of American Medical Colleges, a public relations specialist for the Duke University Medical Center and the public relations director for the UNC-Chapel Hill School of Nursing, I’ve earned in-depth experience in covering health care, including academic medicine, health care reform, women’s health, pediatrics, radiology, and Medicare.